You are on page 1of 1

2/25/2022 Common Checkout Payment Receipt

Payment Receipt Confirmation


Your payment was successfully processed.

Transaction Summary
Receipt Confirmation
Description Amount
$138.75
Total Amount Paid $138.75

Customer Information

Customer Name Maria Arias Receipt Date 2/25/2022


Local Reference ID 9550604439CC Receipt Time 06:45:17 PM EST
L12000084909

Payment Information

Payment Type Credit Card Credit Card Number ******1033


Credit Card Type VISA Order ID 6730348

Billing Information

Billing Address 10356 WEST FLAGLER ST Phone Number 7864094262


Billing City, State Miami, FL This receipt has been emailed to the address below.
ZIP/Postal Code 33174 Email Address MARIAS.PIN18@YAHOO.COM
Country US

https://securecheckout-fl.cdc.nicusa.com/Checkout/Receipt?mode=print 1/1

You might also like